If you have read the headlines or seen the evening news lately, you have probably heard that double the numbers of Americans are now felt to have high blood pressure, and readers are told to “go see your doctor.” This was based on the recently released SPRINT Trial (Systolic Blood Pressure Intervention Trial.) See articles below:
Background: Traditionally a blood pressure of 140/90 or under has been the desired target for patients so as to lower cardiovascular complications. This trial looked at people over 50 without diabetes or heart failure and split the group in half, treating 50% of the group to the traditional goal of a systolic pressure of 140 and the other 50% to a goal of 120. The findings were that the people treated to the lower BP had fewer complications. Specifically there was less heart failure (CHF), cardiovascular death, overall death rate, but more chance of passing out (syncope) and a decrease in sodium or kidney function.
Here are the statistics (the findings in bold are considered significant): The first percentages are those whose Blood pressures were gotten below 120 systolic, the second percentage was those below 140:
· Hear Attack (MI): 2.1% vs. 2.5%, p = 0.19
· Stroke: 1.3% vs. 1.5%, p = 0.5
· Congestive Heart Failure (CHF): 1.3% vs. 2.1%, p = 0.002
· Cardiovascular death: 0.8% vs. 1.4%, p = 0.0005
Important secondary endpoints for intensive vs. routine BP control, absolute event rates:
· Mortality: 3.3% vs. 4.5%, p = 0.0003
· Among patients without kidney disease: ≥30% decline in kidney function p < 0.001
· Hypotension: 2.4% vs. 1.4%, p = 0.001
· Syncope: 2.3% vs. 1.7%, p = 0.05
· Hyponatremia: 3.8% vs. 2.1%, p < 0.001
Comment: In people who are at higher risk for heart attack or heart failure (smokers, prior heart attack, overweight, people older than 65), we should use clinical judgment, but try and get your blood pressure below 130/90 but also monitor your blood tests. We also need to keep in mind that the decrease in mortality and cardiovascular complications between the groups affects approximately 2 out of 100 patients (see the New York Times Editorial).